docvyplněný formulář - konzulát kapverdské republiky v české republice
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vyplněný formulář - konzulát kapverdské republiky v české republice
KONZULÁT KAPVERDSKÉ REPUBLIKY V ČESKÉ REPUBLICE CONSULADO DA REPÚBLICA DE CABO VERDE NA REPÚBLICA CHECA CONSULATE OF THE REPUBLIC OF CAPE VERDE IN THE CZECH REPUBLIC PEDIDO DE VISTO ŽÁDOST O VÍZUM REQUEST OF VISA № do Visto/Číslo víza/Visa № ________/______ № do Recibo/Číslo účtenky/Receipt № _________/_____ FOTO ___________________________________________________________________________ Nome e apelido – Jméno a příjmení – Name and surname ________________________________ * _________________________________________ Nacionalidade – Státní příslušnost – Nationality Estado civil – Rodinný stav – Marital status ___________________________________________________________________________ Lugar e data de nascimento – Místo a datum narození – Place and date of birth ____________________________________________________________________________________________________ Filiação – Rodiče – Parents _____________________________ * _____________________________________________________________________ Profissão – Povolání – Occupation Morada actual – Současné bydliště – Present address __________________________________________ * ________________________________________________________ Número de telefone – Telefonní číslo – Telephone number ____________________________________________________________________________________________________ Referências em Cabo Verde – Osvědčení z Kapverdské republiky – References in Cape Verde ______________________________________ * ____________________________________________________________ № do passaporte –- Číslo pasu – Passport № Emitido por – Vystavil – Issued by ___________________________________________ * _______________________________________________________ Data de Emissão – Datum vystavení – Issued date Válido até – Platnost do – Valid until ____________________________________________________________________________________________________ Motivo de estadia – Účel pobytu – Purpose of stay ___________________________________________ * _______________________________________________________ Data de entrada – Datum vstupu – Date of entry Periodo de permanência – Délka pobytu – Duration of stay ______________________________ * ____________________________________________________________________ Data – Datum – Date Assinatura – Podpis – Signature Šítkova 233/1 - 110 00 Praha 1 - Czech Republic - Tel (Fax): (+420) 224 916 205 - email: [email protected] OBSERVAÇÕES DO REQUERENTE – DOPLŇUJÍCÍ INFORMACE ŽADATELE – OBSERVATION OF APPLICANT ............................................................................................................................. ..................................................................... .......................................................................................................................................................................................... ........ .......................................................................................................................... ........................................................................ ............................................................................................................................. ..................................................................... ............................................................................................................................. ..................................................................... .............................................................................................................................................................................. .................... .............................................................................................................. .................................................................................... ............................................................................................................................. ..................................................................... ............................................................................................................................. ..................................................................... .................................................................................................................................................................. ................................ .................................................................................................. ................................................................................................ ............................................................................................................................. ..................................................................... ............................................................................................................................. ..................................................................... ...................................................................................................................................................... ............................................ ...................................................................................... ............................................................................................................ Este formulário deve ser acompanhado de. Prosím přiložte k tomuto formuláři následující přílohy. Please attach to this form the following appendices. 1. 2. 3. 4. Passaporte com um mínimo de 6 meses de validade / Cestovní pas platný minimálně 6 měsíců / Passport valid for at least 6 months Foto (tamanho de passaporte) / Fotografii pasového formátu / Photo (passport size) Justificativo do pagamento do montante devido pelo visto / Doklad o zaplacení vízového poplatku / Visa payment voucher Documento comprovativo da viagem ou fotocópia do bilhete de passagem / Kopii cestovního potvrzení nebo letenky / Copy of the travel confirmation or ticket Informação bancária / Bankovní spojení / Bank information Raiffeisenbank,a.s. 5763203001/5500 IBAN: CZ 2355000000005763203001 SWIFT CODE: RZBCCZPP
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žádost o vízum
______________________________________ * ____________________________________________________________
Passaporte n° - Číslo pasu - Passport nr.
Emitido por – Vystavil – Issued by
__________________...
DEUTSCHLAND
Embassy of São Tomé e Principe 1211 Connecticut Avenue, NW
1211 Connecticut Avenue, NW, Suite 300
Washington, DC 20036
PEDIDO DE VISTO
VISA APPLICATION FORM
Please complete the form in black ink. Check the boxes that apply and attach:
33 Valid passport
33 ...
República Democrática de S. Tomé e Príncipe
Address and Telephonein USA.
Endereço e telefone nos EUA.
5)______________________________________________________________________
Profession and Marital Status.
Profissão e Estado Civil
6)________...
Jméno (jména)
Datum narození
